- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $6,309.57 / $13,182.57
| Facility | | $1,023.29 | $6,309.57 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 80 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $5,370.32
| Facility | | $2,754.23 | $3,630.78 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $2,691.53 / $26,302.68
| Facility | | $575.44 | $2,691.53 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,623.41 / $11,220.18
| Facility | | $2,818.38 | $5,623.41 | $11,220.18 |